PROJECT SUMMARY/ABSTRACT Food insecurity, the lack of consistent access to enough food for an active and healthy life, is an important social determinant of health that affects over 40 million Americans. Food insecurity is associated with an increased risk of diabetes, hypertension, and cardiovascular disease. Because of the prevalence and potential for poor health outcomes, national and state organizations recommend that health systems address food insecurity in order to improve patient care and reduce health disparities. Few clinicians assess patient?s food security in practice, though, and the pathways by which food insecurity leads to disparities in cardiovascular disease remain unclear. The research goals of this study are to advance our knowledge of the relationship between food insecurity and cardiovascular disease and test an innovative tablet-based application for primary care practices to address food insecurity in order to improve cardiovascular health. To accomplish these goals, the principal investigator (PI) proposes a career development program that blends rigorous methodical training with an innovative research agenda. Aim 1 will use national survey data to determine the pathways through which food insecurity is associated with cardiovascular disease using structural equation modeling. Aim 2 will engage patients, clinicians, clinic staff, and key community leaders in a highly iterative process of user- centered design to modify and tailor a tablet-based application for primary care practices to address the pathways identified in Aim 1. Aim 3 will determine the feasibility and potential impact of the tablet-based app in a pilot, pragmatic trial in one primary care practice. To successfully accomplish these Specific Aims, the PI will capitalize on the outstanding research environment at Wake Forest School of Medicine and an engaged interdisciplinary mentorship team (Drs. Rosenthal, Bertoni, Ip, Miller and Vitolins) of exceptionally qualified senior scientists. With guidance from his expert mentor team and through didactic coursework and hands-on experience, the PI will obtain the necessary training in structural equation modeling, cardiovascular epidemiology, clinical informatics, and pragmatic clinical trials to become an independent investigator and leader in reducing disparities in cardiovascular disease by addressing the social determinants of health. This proposed K23 award complements National Heart, Lung, and Blood Institutes? strategic focus on investigating factors that account for differences in health among populations and optimizing clinical and implementation research to improve health and reduce disease. This Mentored Patient-Oriented Research Career Development Award will advance our understanding of the chronic health effects of food insecurity and will be a timely catalyst for the PI in achieving his long-term goal of becoming an independent investigator focused on improving the health of low-income and vulnerable populations.